From the Pioneer Advisory Group: Can We Stop Dementia Before It Starts?

Few diseases invoke more fear in patients and families than dementia (e.g., Alzheimer’s Disease (AD), progressive multiple sclerosis, Pick’s Disease). Surveys have shown the fear of dementia—especially AD—far outweighs concerns of a diagnosis of cancer, stroke, or cardiovascular disease. Perhaps this fear arises from two concerns: (1) dementia robs us of what makes us human—memory, reasoning, emotions, language—and (2) in most cases there are no effective treatments to cure or palliate the disease. While diagnostics for certain forms of dementia are progressing—allowing us to sort out the reversible causes of dementia, such as hydrocephalus, electrolyte or blood sugar imbalances, brain tumors, and brain injuries—once the diagnosis of AD or Pick’s disease is made, there is little we can do aside from manage the comfort and safety of the patient and family.

What if we could prevent or delay dementia?

In the mid-1960s, the incidence of heart attacks and stroke were increasing at an alarming rate. Great strides were made in treating existing cardiovascular disease, followed by programs at preventing the disease in the first place. These prevention methods included exercise, diet, and the tracking of key incidence indicators such as blood pressure, body mass index, and cholesterol levels to maintain a quantifiable physical health. Could we use similar prevention methods for preventing or delaying dementia?

While there are many resources available online for mental exercises—such as mental challenges like crossword puzzles, introducing novelties in the environment, and adult education—how do we know if these mental exercises work? Discussing mental resilience is tantalizing, but how much mental capacity do we need . . . and how long will it last?

What do you think? What are some good measuring sticks to quantify our mental state? Are existing measures of language, memory, perception, emotions, and cognitive skills suitable to allow comparison of a control group with an experimental arm? Are these measures suitable for comparing across experiments? How precise do we need to be?

We certainly have measures for identifying and quantifying protocols to prevent cardiovascular disease. What about Alzheimer’s Disease?

This commentary originally appeared on the RWJF Pioneering Ideas blog.

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